Provider Demographics
NPI:1619198660
Name:CHAPMAN, MARIANNE (LMHC)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SEVILLA BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-5636
Mailing Address - Country:US
Mailing Address - Phone:904-716-2949
Mailing Address - Fax:931-459-2326
Practice Address - Street 1:300 SEVILLA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6636
Practice Address - Country:US
Practice Address - Phone:904-710-9420
Practice Address - Fax:931-459-2326
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3719429OtherTAX ID #
FLMH4092OtherSTATE OF FL-LICENSE #
FLZ7649OtherBCBS OF FL-PROVIDER #